Hair Transplant on Scar – Cicatricial Alopecia
Patients with scars on their head can now consider hair transplant on scar tissue since satisfactory results can be achieved. Cicatricial Alopecia is categorized into two main groups; primary and secondary cicatricial alopecia. Primary or unstable cicatricial alopecia is a chronic inflammatory disease where follicles are destroyed as a result of folliculo-centric disease. Secondary or stable cicatricial alopecia comes up as a result of conditions affecting structures outside the follicular unit and affecting near-by hair follicles. In both types, the resulting hair loss is irreversible. Permanent hair loss can be disfiguring and damage an affected individual’s self esteem. Follicles destroyed by cicatricial alopecia will never re-grow hair because there is currently no available medical treatment will stimulate hair follicle neo-genesis. Hair transplantation is the only way to regain back hair growth in the scarred areas. Closing up of the scar with hair transplant can bring out satisfactory results in selected patients. The most important factor in hair transplantation in secondary cicatricial alopecia is the quality of the scar; while in primary cicatricial alopecia there are difficulties in establishing if the patients are in the stable period, and if disease will or will not re-activate. Another major problem is patients with insufficient donor; in such cases, reduction of the bald area or primary excision and if not possible alternative donor areas should be considered.
FUE is the most ideal method to avoid creating an additional scar; since the patients already have existing scars from the disease. Even with scars on the occipital region, grafts can still be extracted from the intermediate solid area with FUE. The patients with insufficient donor on the scalp can use body hair as donor.
Secondary cicatricial alopecia
It is important to evaluate the vascular supply in atrophic scars. Graft survival will be lower in areas with poor blood circulation. In such cases, 2 sessions can be planned. The first session will improve the scar quality and the vascular circulation. For large scars in stable cicatricial alopecia, primary excision can be done if possible or excision together with hair transplantation.
Primary cicatricial alopecia
Hair transplantation may be unsuccessful in the patients who are not in stable period as the disease may re-activate. Generally, a test hair transplant can be done after a 1-2 year stable period. If the test session is successful (no re-activation) then a full session can be done.
Satisfactory results can be achieved by patients with sufficient donor. FUE should generally be the preferred method for hair transplantation in cicatricial alopecia patients.